Vertigo

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Vertigo is not really a disease, but a symptom caused by various reasons. It a strange feeling that you or your environment is moving or spinning. It is different from dizziness in that vertigo is described as an illusion of movement. When you feel as if you yourself are moving, it\’s known as subjective vertigo, and the perception that your surroundings are moving is called objective vertigo.

Although dizziness and vertigo are often used to interpret each other, they are still not the same thing. It is to be noted that while all vertigo is dizziness, not all dizziness is vertigo.

Causes

Vertigo can be caused by problems in the brain or the inside ear.

Benign paroxysmal positional vertigo (BPPV): It is the most familiar type of vertigo. It is characterized by the feeling of motion initiated by sudden head movements or moving the head in a certain direction. This type of vertigo is seldom serious and can be treated.

The inflammation within the inner ear (labyrinthitis) may also cause vertigo, characterized by abrupt arrival of vertigo and may be linked with loss of hearing ability. The most common reason of labyrinthitis is a viral or bacterial infection in nature.

Meniere\’s disease is composed of a triad of symptoms: It can be described as the episodes of vertigo, ringing in the ears, and loss of hearing ability. People have the sudden onset of severe vertigo, variable hearing loss, as well as periods in which they are free from symptoms.

Acoustic neuroma is a type of tumor that can result in vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.

Decreased blood flow to the base of the brain may also cause vertigo. Bleeding into the back of the brain or cerebellar hemorrhage is characterized by vertigo, headache, difficulty while walking, and inability to look toward the site of the bleed. This causes the person\’s eyes to gaze away from the side with the problem. Walking is also extremely hampered.

Vertigo is often the persisting symptom in multiple sclerosis. The onset is generally sudden, and test may reveal the inability of the eyes to move past the midline toward the nose.

Head trauma and neck injury may also cause vertigo, which normally goes away automatically.

Migraine which is a severe form of headache may also bring about vertigo. The vertigo occurs subsequent to a headache. There is often a previous history of similar episodes but no permanent problems.

Perilymph fistula is a leakage of inner ear fluid into the middle ear. It can cause after a head injury, radical changes in atmospheric pressure (such as at the time of scuba diving), physical exertion, ear surgery, or chronic ear infections. Besides dizziness and nausea, instability when walking or standing is another notable symptom that increases with activity and calms down if taken rest. Some babies may be born with perilymph fistula, usually together with hearing loss that is evident at birth.

Mal de debarquement syndrome (MdDS) is balance disarray in which you have a feeling as if you\’re incessantly rocking or bobbing. It generally occurs after an ocean cruise or other sea travel. Usually, the symptoms will vanish in a matter of hours or days after you reach land. However, if the cases are severe it can remain for months or even years.

Symptoms

Vertigo indicates that there is a feeling of motion either of the person or the environment. This must not be mixed with symptoms of dizziness or fainting. If true vertigo exists, there is a feeling of confusion or motion. The patient may also experience any or all of these symptoms:

  • Nausea or vomiting
  • Sweating
  • Abnormal eye movements
  • The duration of symptoms can vary from minutes to hours, and symptoms can be stable or episodic. The onset may be because of a movement or shift in position. It is important to inform the doctor about any new head trauma or whiplash injury and any new medications the patient is taking.
  • The patient may experience hearing impairment and a ringing sensation in the ears.
  • The patient might also face visual disorder, weakness, difficulty speaking, decreased level of consciousness, and difficulty in walking.

Diagnosis

Diagnosis of vertigo consists of clinical history, physical and neurological assessment, blood tests, and imaging tests (e.g., CT scan, MRI scan).

Physical exam includes checking blood pressure and heart rate. Neurological examination incorporates examining facial and vestibular nerves and muscles, strength, coordination, balance, and walking (gait).

The positional vertigo test is carried out to help differentiate peripheral from central vestibular disorders. In this test, the patient is instructed to sit on a table with the head turned to the side. The physician then supports the head and lowers it gently below the table while the patient lies on back. The patient informs symptoms of vertigo while the physician tries to find out circular movement of the eyes (called nystagmus).

Electronystagmography (ENG) is a neurological examination performed to assess the vestibular system involving testing hearing in both ears (it is called audiometry tests), examining eye movements, and assessing responses to changes in posture and position.

Blood tests consist of a complete blood count (CBC) and kidney and thyroid panels in order to exclude systemic diseases (e.g., kidney disease, hypothyroidism). If the patient is under medication, drug levels are also obtained.

Imaging tests may be done to find out brain abnormalities (e.g., stroke, tumor). Computed tomography (CT scan) produces x-ray images of the brain and magnetic Resonance Imaging (MRI scan) uses a magnetic field in order to present detailed images of brain tissue and arteries in the neck and brain.

Treatment

Vertigo can be treated with oral medicine, or medicine placed on the skin (a patch), or drugs given through an IV.

Specific types of vertigo may require added treatment and medical appointment.

Bacterial infection of the middle ear needs to be treated with antibiotics.

For Meniere\’s disease, along with symptomatic treatment, people might be suggested to live on a low salt diet and may need medication in order to raise urine output.

A hole in the inner ear bringing about frequent infection may require appointment to an ear, nose, and throat (ENT) specialist for surgery.

In addition to the drugs used to treat benign paroxysmal positional vertigo, several physical exercises can be followed to get rid of this condition.

Vestibular rehabilitation exercises include having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side again until the vertigo stops. This is carried on until the vertigo resolves totally.

Particle repositioning exercise is based on the belief that the condition is due to displacement of small stones in the balance center i.e. vestibular system of the inner ear. The head is positioned again so that the stones move to their normal position. This exercise is repeated until the abnormal eye movements go away.

Medications

Commonly prescribed medications for vertigo include:

  • meclizine hydrochloride (Antivert)
  • diphenhydramine (Benadryl)
  • scopolamine transdermal patch (Transderm-Scop)
  • promethazine hydrochloride (Phenergan)
  • diazepam (Valium)

These medications should be taken only as directed by your doctor and under the supervision of a doctor.

Prevention

  • People whose balance is affected by vertigo really need take precautions in order to prevent injuries from falls.
  • People under the risk of having stroke must control their high blood pressure and high cholesterol and quit smoking.
  • Patients with Meniere\’s disease should limit salt in their diet.

Vestibular rehabilitation exercises:

The aim of this rehabilitation is to assist the patient adjust (accommodate) to the balance problem so that they can reduce recurrent symptoms. The following is a list of vestibular exercises that may be prove effective.

1. Seated or in bed.

  • Eye movements: at first move the eyes slowly and then quickly up and down, side to side, and diagonally too. Keep focus on your finger as you move it from 1 foot to 3 feet away from the face.
  • Head movements: move the head slowly at first, then faster. Keep your eyes open, bending forward and backward, turning and tilting from side to side, and moving diagonally. Repeat the same with the eyes closed.

2. Standing

  • Repeat section 1 exercise while standing.
  • Change from a sitting to a standing position, first with eyes open, and then closing your eyes.
  • Throw a ball from hand to hand above eye level.
  • Now throw a ball from hand to hand under the knees.
  • Change from sitting to standing position by turning first to one side and then to the other.

3. Moving about

  • Walk across the room first with eyes open, and then closing your eyes.
  • Walk up and down a slope with eyes open, followed by closing your eyes.
  • Walk up and down steps with eyes open, and then with eyes closed.
  • Sit up and lie down in bed
  • Sit down in a chair, and then stand up
  • Try to recover balance when pushed in a specific direction.
  • Throw a ball and then catch it
  • Engage yourself in any game that involves stooping or stretching and aiming, for examples bowling, volleyball, or shuffleboard.